Chest Pain Flashcards
What chest pain conditions require immediate treatment? (3)
pericarditis
aortic dissection
pulmonary embolism
When encountered with a patient with chest pain, we ask the following questions: (5)
1.character of pain
2. exacerbating or relieving factors
3. ass. symptoms
4. duration, progression
5. decline in the threshold for severe anginal discomfort
describe pain occuring with myocardial ischemia impending infarction
- pain usually over 20 mins
- retrosternal area, radiats to the arms, back, neck, lower jaw
- squeezing, pressing, sensation of heaviness,
- breathing/posture does not notably influence the severity
symptoms can resemble ischemia - bradycardia, hypotension, dizziness, fainting (inferoposterior wall ischemia)
what symptoms are high risk?
- severe ongoing pain
- pain lasts more than 20 minutes
- new pain at rest or with minimal activity
- severe dyspnea
- loss of consciousness
what are features of pain that are not charactesrist of myocardial ischemia (7)
- pleuritic pain (bol koja se pogarsava disanjem i kasljanjem)
- primary or sole location of discomfort in the middle or lower abdominal region
- pain that may be localized at the tip of 1 finer, pogotovo preko apexa na lijevoj strani
- pain reproduced with movement or palpation of the chest wall or arms
- pain that lasts for many hours, constant
- brief episodes that last few seconds
- pain that radiates into the lower extremtities
list non-ischemic causes of chest pain (4)
- reflux
- pulmonary embolism
- aortic dissection
- costochondral pain
When is patient considered to have acute MI
When patients have new or presumably new ST elevation of greater than 1 mm in two contiguous leads, they should be considered to have acute myocardial infarction.
Patients with new or presumably new left bundle branch block (LBBB) should be treated how?
Patients with new or presumably new left bundle branch block (LBBB) should be treated similarly to those with ST segment elevation.
ECG criteria for STEMI (3)
- ST elevation >1mm in 2 or more adjacent limb leads or >=2 mm in 2 or more adjacent chest leads
- new LBBB
- posterior changes: deep ST depression and tall R waved in leads V1 to V3
when to refer a patient to a cardiologist? 6
- Means previous MI or other abnormalities
- The symptoms are not controlled by the prescribed therapy
- The presence of an ejection systolic murmur above aortic orifice
- Symptoms of unstable angina
- Uncertain or atypical symptoms
- Patients who will benefit from further examinations
Treatment of angina pectoris
A- aspirin, antianginal drugs, ACE inhibitors
B- beta-blockers, blood pressure pressure)
C- cessation of smoking (cessation smoking),cholesterol
D- diabetes mellitus, diet
E-exercise (physical activity), education
POST MI therapy : prior MI no heart failure
beta blocker, aspirin, ACEi, statins
Post MI therapy: prior MI with heart failure
beta blocker, aspirin, ACEi, statins, spironolactone, loop diuretics
post MI therapy, prior MI with DM
additionally intensive insulin therapy for 3 monthts
what to monitor post MI
renal function
serum potassium
lipids, AST, ALT, CPK
what to consider in choice of revasculariation
comorbidities,
benefits and risks of this intervention
when the role of revascularization or the revascularization strategy is unclear,
the discussion should include the cardiologist, cardiac surgeon, and other health professionals relevant to the patient’s needs.
Clopidogrel: indication, side effects contra-indications
indication: alternative to aspirin post MI and angina
side effects: nausea, dyspepsia, hemorrhage, idiopathic thrombocytopenic purpura
contraindications: allergy, intracranial hemorrhage
beta blockers examples
propranolol
metoprolol
atenolol
nadolol
beta blockers indication, monitoring, side effects, contra indications
indication: angina and post MI (1st choice, hypertension, congestive heart failure
montioring: vital sings, ECG
side effects: common dizziness, fatigue, depression, serious: bradycardia, severe congestive heart failure, bronchospasm
contra indications: peripheral vascular diseases, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and asthma
Calcium channel blockers: examples
nifedipine, diltiazem, verapimil, amlodipine
calcium channel blocker: indication, monitoring, side effects, contra indications
indication: angina and post Mi, HTN, certain arrythmias
monitoring: vital signs
side effects: common: constipation, dependent edema
serious: heart block, hypotension, syncope, bradycardia
contra indications: allergy
nitrates: example (2)
- isosorbide mononitrate
- transdermal nitroglycerin
nitrates: indications, dosage issues, monitoring, side effects, contraindications
indication: angina
dosage issues: tolerance requires use of intermittent schedule
3. monitoring: vital signs
4. side effects: common headache, serious orhtostatic hypotension, thrombocytopenia
contra indication: allergy
examples of ACEis
captopril
enalapril
ramipril
ACEi indications, dosage issues, monitoring, side effects, contraindications
- indication: congestive heart failure, post MI with poor left ventricular function, hypertension, diabetic nephopathy
- dosage issues: adjust dose according to renal function
- monitor serum creatinine and potassium
- side effects: common cough, hypotension, dizziness, serious - angioedema, acute renal failure, severe hypokalemia, severe hypotension
contraindications: allergy
statins indications, monitoring,side effects, contra indications
dyslipidemias, ishcemic heart disease prevention
monitor lipids AST ALT CPK
side effect: minor AST ALT elevation (2x baseline); serius: hepatotocivity, rhabdomyolysis
contraindication: allergy, active hepatic disease
diuretics indication, monitoring, side effects, contra indications
indication: conestive HF, pulmonary edema, hypertension
monitor: serum electrolytes
side ffects: hypokalemia
contra indications: allergy, anuria, hepatic coma, electrolyte imbalance
digoxin indication, dosage issue, monitoring, side effects, contra indications
indication: atrial fibrilation, severe congestive heart failure
2. renal dosing adjsutemnt
3. monitor vital signs, serum creatinine, serum digoxin level
4. side effect: common nausea, anorexia, weakness, serios severe brady cardia, ventricular arrythmias, delirum
contra indications: allergy certain arrythmias, idiopathic hypertrophic cardiomyopathy
